Endometriosis, the presence of viable endometrial tissue outside the uterine cavity (its usual location), affects about 2-8% of women in the general population and 30-50% of women with infertility (Strathy et al., 1982; Verkauf 1987) and is a major cause of pelvic pain and infertility. However, both pain and infertility are non-specific symptoms of many disorders and there is currently no generally useful test for endometriosis except surgical examination.
Despite the lack of diagnostic tests, once diagnosis is made there are effective treatments. Surgical therapy for endometriosis can relieve pain, but given the lack of symptom specificity, physicians are reluctant to perform possibly unnecessary surgery, leading to delays in diagnosis and progression of the disease. An even greater problem is the uncertainty surrounding endometriosis and infertility. Only about half of women with endometriosis meet the diagnostic criteria for infertility and there is no test to know whether a patient's fertility will benefit from surgical therapy of endometriosis. Furthermore, many of the women with endometriosis-related infertility have no other symptoms. In fact, it has been calculated that the number of women with possible endometriosis who need to undergo surgery in order to help one conceive (number needed to treat (NNT)) is about 12. Furthermore, surgery can delay fertility treatments due at least in part to various limitations impose pre- and post-operatively.
Provided herein is a sensitive test for endometriosis and/or subfertility. Also provided are additional methods for managing treatment of subjects with endometriosis and subfertility. Such tests and methods avoid delays in diagnosis and ineffective treatment and/or reduce the need for invasive procedures. Further provided are methods for assessing the likelihood of successful implantation of in vitro fertilized ova and/or frozen embryos.